Abstract

Intestinal protozoa account for a minority of cases of acute traveler's diarrhea, but they are common pathogens in travelers who experience protracted diarrhea during or after travel. Evaluation of the traveler with chronic diarrhea should include a careful examination for typical infecting organisms, such as
Giardia
and
Entamoeba
species, as well as for emerging parasites, such as
Cryptosporidium
species,
Cyclospora
species, and microsporidia. The microbiology, epidemiology, clinical presentation, and treatment of the most common intestinal parasites found in travelers are presented in this minireview.

Topic:

Issue Section:

It has long been recognized that most cases of traveler's diarrhea are acute in nature and tend to resolve within 5–10 days after the onset of symptoms. Common organisms that cause acute traveler's diarrhea are enterotoxigenic
Escherichia coli, Campylobacter jejuni, Shigella
species and
Salmonella
species. For patients who are infected with these species, the duration and severity of illness are shortened with antimicrobial treatment. Contrary to popular belief, only a small percentage of cases of acute traveler's diarrhea are due to parasites. Numerous studies have identified intestinal protozoa in only 0%–12% of cases of acute travelers diarrhea (summarized in Peltola and Gorbach [
1
]). In contrast, intestinal protozoa are the most common infecting organisms identified in travelers with chronic diarrhea. For example, studies performed in Nepal demonstrated that giardiasis was more frequently diagnosed in travelers with diarrhea of>2 weeks' duration than it was in those with diarrhea of <2 weeks' duration [
2
].

The risk factors for acquisition of intestinal parasites have not been well defined. In general, duration of stay, hygiene, and level of socioeconomic development in the host country have been thought to be associated with the acquisition of intestinal protozoa [
3
]. The most common infecting organisms identified are
Giardia intestinalis, Cryptosporidium parvum
, and
Entamoeba histolytica
, although a smaller proportion of infections are due to the microsporidiae and to
Isospora belli
. In recent years,
Cyclospora cayetanensis
has been recognized as a causative organism of chronic diarrhea in returning travelers. In this minireview, I present the microbiology, epidemiology, clinical presentation, and treatment of the most common intestinal parasites found in travelers.

Giardia lamlia
, also known as
G. intestinalis
or
Giardia duodenalis
, can produce infection in humans and is also a zoonotic agent. Molecular analysis of isolates of
Giardia
species has shown that these parasites belong to distinct genotypes, some of which demonstrate host preferences and will probably be reclassified as a new species [
4
]. Infections with
Giardia
species occur worldwide. The ingestion of cysts found in contaminated water or food results in asymptomatic infection, acute self-limited diarrheal illness, or chronic gastrointestinal complaints with intermittent diarrhea. Urticaria and eosinophilia are rarely associated with giardiasis, as is the case with other atopic manifestations.

The problem here is not the law enforcement officers but the hate rhetoric from the likes of Black Lives Matter movement. The fact that almost 40% of the prison population is black and that does not include the blacks walking our streets that are ex convicts. The blacks have only themselves to blame for so called racism.It is not racism but fear of violence

Considering that you can’t walk thru center city Baltimore without the whiff of stanky blunts on every corner, it’s a mystery how there’s still apparently not enuf there to “chill out” the murder rate there. /sarcasm off/

PCness has run amok…the police commissioner has no right to apologize. Is the black community going to express remorse for BLM calling for the death of cops? For all the police ambushed by some coward with an agenda that is acceptable to that community? For wasting all the opportunities and special treatment they’ve been given by the very people they despise? For demanding no consequences for their actions? Now whenever something happens to a black person, it has to be about race…..and then that pathetic need to show up whitey kicks in. Remember the old saying ‘slaves (of any color) do not want to be free. They want to be the masters.’

How about apologizing for 200 years of black crime…How about thanking white people for “integration” they created for the black man…How about thanking white people for all the homes that blacks live in that were built by white people (don’t think you can find ONE home in all of Baltimore built by a black man))… How about thanking white people for the base that they’ve given the black race.